The St. Louis region has experienced a sharp uptick in flu cases in recent weeks, according to Washington Universityphysicians at Barnes-Jewish Hospital who say they are dealing with a severe flu outbreak that includes deaths from the illness. The deaths primarily were of otherwise healthy young and middle-aged adults not vaccinated against influenza, according to the physicians.
The H1N1 strain of the flu is causing the most problems, just as it did in 2009, disproportionately affecting younger patients, some of whom are so critically ill they are being treated in intensive care units.
“We have seen a steep rise in flu cases, and we’re treating some very, very sick patients from the St. Louis area and others who have been transferred here from hospitals in the region,” said Steven Lawrence, MD, a Washington University infectious disease specialist at Barnes-Jewish.
So far this season, 320 cases of influenza have been diagnosed at Barnes-Jewish, with an average of 10 to 12 new cases daily. While most patients have been treated and released, some young and middle-aged patients have developed severe cases of rapidly progressive influenza leading to serious illness.
During the current flu outbreak, nine patients ranging in age from their mid-20s to mid-60s have died from flu-related illness at Barnes-Jewish Hospital. In all, about 35 patients with severe flu illness have been treated in the hospital’s intensive care units, with many of the sickest patients transferred from other hospitals in the region because of advanced treatments available at Barnes-Jewish.
Some patients require dialysis because their kidneys have shut down, and others are receiving breathing assistance with heart-lung machines through a process called ECMO, which is short for extracorporeal membrane oxygenation. This specialized procedure has been shown to benefit patients with extremely severe cases of the flu. It involves running a patient’s blood through a machine that removes carbon dioxide and adds oxygen before blood is returned to the heart and pumped to the rest of the body.
Barnes-Jewish has used ECMO to treat patients whose breathing problems have not improved on traditional ventilators. Only a few hospitals in the region offer ECMO, which requires expertise from cardiothoracic surgeons, critical care physicians, nurses and perfusionists to manage these cases.
For patients with life-threatening infections who have not responded to traditional flu treatments like antiviral drugs Tamiflu and Relenza, Washington University physicians at Barnes-Jewish also are evaluating an investigational intravenous form of Relenza.
Washington University physicians at St. Louis Children’s Hospital have treated about 12 patients with influenza in the hospital’s intensive care unit, with two patients on ECMO. No flu-related deaths have been reported at Children’s.
Because of the flu’s severity, physicians are strongly encouraging people to get the influenza vaccine if they have not already done so because the flu season has not yet peaked and the H1N1 influenza virus could be circulating for at least another month and possibly into the spring.
“It is not too late to get a flu shot,” Lawrence said. “Most of the influenza patients we’ve seen who are sick enough to be hospitalized did not get vaccinated. The vaccine is very effective against H1N1 flu, particularly in the younger and middle-aged patients hit hardest by this strain. Even though it does not prevent all cases, people who have been vaccinated and later get the flu often have less severe symptoms.”
The Centers for Disease Control and Prevention recommends annual influenza vaccination for everyone 6 months and older. The seasonal flu vaccine protects against two strains of influenza A, including H1N1, as well as influenza B strains. The vaccine takes two weeks to be fully effective, but that should not discourage people from getting vaccinated, Lawrence added.
For patients sick with the flu, Tamiflu and Relenza are available by prescription. The drugs can help reduce the duration and severity of the illness, particularly if given within 48 hours of developing flu symptoms, such as sudden fever, body aches, chills and coughing.
The risk of severe flu and flu complications generally is higher among children younger than 5, adults age 65 or older, pregnant women and people with chronic medical conditions like asthma, diabetes or heart disease. In most flu seasons, the majority of influenza-associated hospitalizations and deaths are among adults ages 65 or older. However, during the 2009 pandemic, just like this flu season, H1N1 flu caused more illness in children and young adults than in older adults. This is likely due to partial protection in older adults who were exposed to a similar flu virus decades ago.
In addition to contacting medical providers for treatment advice, Lawrence also cautions that people with the flu should get plenty of rest and stay home for at least 24 hours after their temperature returns to normal, to avoid spreading flu to others.